Johnston M V, Findley T W, DeLuca J, Katz R T
Kessler Institute for Rehabilitation, Orange, N.J. 07052.
Am J Phys Med Rehabil. 1991 Feb;70(1):40-56. doi: 10.1097/00002060-199102000-00008.
There are basic principles and techniques of measurement that are relevant across biomedical disciplines. The purpose of this article is to explain some of the most important of these for medical rehabilitation, to illustrate how to use them to choose assessment instruments and to describe the nature of measurement in medical rehabilitation by examples in brain injury rehabilitation. Reliability is basic to any scientific measure. Validity, the ultimate criterion, is closely associated with the purpose of the measure. Content validity, criterion validity and construct validity are explained. Sensitivity to rehabilitative interventions and significance in patients' real lives (ecological validity) are emphasized. Measures of functional outcomes (disability) may show improvement after rehabilitation even when impairment measures do not. An extensive but selected list of measures of coma, global status, disabilities, communicative and cognitive impairments, and handicaps is presented, and their main uses are illustrated. Examples illustrate how to choose measures to study comprehensive program-level outcomes, to study learning-based interventions and to develop a general purpose database. Although there are many measures of activities of daily living and mobility, little published evidence of reliability and validity could be found even for some well-known scales. Ecologically valid and sensitive outcome measures are especially needed. Studies of the clinical utility of measures were also scarce. Many of these gaps can be spanned by clinical researchers with limited resources. Physical medicine and rehabilitation will benefit from formal studies of the reliabilities and validities of both its old and its new measurement instruments and by increased sophistication in choice of measures.
在生物医学各学科中，存在一些相关的测量基本原则和技术。本文旨在阐述其中一些对医学康复最为重要的原则和技术，举例说明如何运用它们来选择评估工具，并通过脑损伤康复的实例描述医学康复中测量的本质。可靠性是任何科学测量的基础。有效性作为最终标准，与测量目的紧密相关。本文对内容效度、标准效度和结构效度进行了解释。强调了对康复干预的敏感性以及在患者现实生活中的重要性（生态效度）。即使损伤测量未显示改善，功能结局（残疾）测量在康复后可能会显示出改善。本文列出了一份广泛但经过筛选的昏迷、整体状况、残疾、沟通和认知障碍以及残障测量清单，并说明了它们的主要用途。实例说明了如何选择测量方法来研究综合项目层面的结局、研究基于学习的干预措施以及建立通用数据库。尽管有许多日常生活活动和移动性的测量方法，但即使对于一些知名量表，也几乎找不到已发表的关于可靠性和有效性的证据。尤其需要具有生态效度且敏感的结局测量方法。关于测量临床效用的研究也很匮乏。资源有限的临床研究人员可以弥补其中许多差距。物理医学与康复将受益于对其新旧测量工具的可靠性和有效性进行的正式研究，以及在测量选择上更加精细的操作。
